PAPER 06/CE/40
Peer Assisted Learning (PAL) in the MBChB
This report summarises the developments in Peer Assisted Learning in recent years.
The Curriculum Executive is asked to:
1. Discuss, amend and approve the Precepts for PAL.
2.
Note the Framework for PAL Project Planning and Implementation and, if appropriate, encourage
its use in appropriate areas of the curriculum.
3.
Note the current PAL projects in the MBChB.
4.
Approve in principle the ongoing and planned future development in this area.
5.
Provide feedback to Dr Michael Ross on any aspect of this paper and PAL in the curriculum.
The GMC stated in Tomorrow’s Doctors that medical graduates must “Be able to demonstrate
appropriate teaching skills”. Applications to Foundation and Specialist Training posts now include
details of graduates’ teaching experience. ‘Teaching others’ is one of the 8 domains of the PPD theme
in the MBChB. Curriculum mapping of opportunities to gain experiences related to teaching or which
may be transferable to teaching is underway, however a key component of the strategy is to provide
students with more formal teaching experience within the programme. Additionally revision of
content, role-modelling, peer mentoring / support, scaffolded learning and increased observation of
practice and feedback have been highlighted in many studies as key benefits which may be achievable
using PAL approaches.
A PAL website is being developed on EEMeC https://www.eemec.med.ed.ac.uk/PAL/
The Ten Peer Assisted Learning (PAL) Precepts
These guiding Precepts have arisen through solving problems in practice, and are recommended as a
statement describing our approach to PAL in the MBChB.
1. PAL is supplemental to standard teaching and learning methods and must not be considered a
replacement for staff-led teaching activities.
2. Detailed project-plans should be written up for all PAL initiatives to offer experience in planning a
teaching activity, to aid easy consultation and implementation with others and to serve as a detailed
record of the activity.
3. Academic staff responsible for the subject must agree to the introduction of PAL and be aware of the
proposed content and methods.
4. All new PAL initiatives will be reported to the relevant Module Organiser, Year Director and Year
Curriculum Committee.
5. The PAL coordinator appointed by the Medical Teaching Organisation will keep a register of PAL
activities in the MBChB Programme.
6. Appropriate training will be provided if required for student tutors by the responsible academic and /
or the Medical Teaching Organisation.
7. Organisers will aim to offer all students equitable access to participation as a student tutor or tutee,
across the 5-year programme and within any year cohort.
8. All students participating in PAL should be made aware of the limitations of this approach, and be
encouraged to question any teaching that conflicts with that provided by academic staff.
9. PAL participants must not miss scheduled teaching or clinical attachments to attend PAL sessions.
10. All organised PAL activities will be evaluated and regularly reviewed.
PAL definitions
In undergraduate medical education the term ‘PAL’ tends to mean organised educational programmes
in which students tutor or teach their peers. The terminology can be confusing, and so the following
definitions are used in the PAL programme at the University of Edinburgh….
Teaching: assisting the learning of someone else
Peers: healthcare students from any year
Tutors: those assisting the learning of their peers
Tutees: those being assisted
Reciprocal: projects in which students may be both tutor and tutee
Session: events in which tutors and tutees interact (e.g. a tutorial)
Project: discrete PAL initiatives (e.g. Y4-Y1 stress PAL Project)
Project planning and implementation framework
The answers to these questions will form the detailed project plan which can be negotiated with other
interested parties such as the responsible academic/s and will serve as a clearly stated shared vision to
guide implementation and evaluation. Examples of how to complete the framework are available from
the MTO PAL Coordinator.
BACKGROUND
Q1. What is the current situation and context in the curriculum?
Q2. Why is this PAL project being considered now?
Q3. Who is responsible for the project and who will lead it?
AIMS
Q4. What are the aims and objectives of the project for tutors?
Q5. What are the aims and objectives of the project for tutees?
Q6. What are the aims and objectives of the project for the institution?
TUTORS
Q7. Who will be tutors and how will they be recruited?
Q8. What training will tutors require and how will this be provided?
Q9. How else will tutors prepare themselves and reflect afterwards?
TUTEES
Q10. Who will be tutees and how will they be recruited?
Q11. What related prior knowledge and experience will tutees have already?
Q12. What information and preparation will tutees require before the interaction?
INTERACTION
Q13. What will be the format of the interaction, and what resources are required?
Q14. What would be a typical plan of activities during the PAL interaction?
Q15. When and where will PAL interactions occur, and how will they be arranged?
EVALUATION
Q16. What feedback will be collected from participants and how will it be used?
Q17. How else will the project be piloted and evaluated?
Q18. What are the academic hypotheses and how will they be tested?
INSTITUTION
Q19. Who are potential stakeholders in the project?
Q20. What are the staff time and funding implications of the project?
Q21. How could the project be developed, and how might it affect the curriculum?
REALISATION
Q22. What are the potential pitfalls or barriers to the success of this project?
Q23. What are key points on the timeline for this project?
Q24. What actions need to be taken to develop the project, and by whom?
Current PAL in the MBChB
Pre-existing / informal:
 Intercalated students subsequently teaching in Y1-2 tutorials (has been informally arranged by
relevant Module Organisers)
 Intercalated students giving a lecture in their subject (Royal Medical Society)
 Small-scale exam revision from year above (Royal Medical Society)
 Academic families (Medical Students Committee)
From 2005:
 Y4-Y3 Procedures PAL (Organiser: Lisa Anderson)
 Y4-Y1 Stress PAL (Organiser: MR & Karen Simpson)
 Y4-Y3 OSCE / OSCA revision (Organiser: Medical Students Committee)
From 2006:
 Y4-Y1+2 Anatomy PAL (Organiser: Dr Gordon Findlater)
 Y4-Y3 Cambridge students OSCE PAL (Organiser: Y4 Cambridge transfer students)
 Y4-Y2 OSCE revision (Organiser: Year 4 students)
 Y4-Y3 ‘How to approach the OSCE / OSCA’ booklet (Organiser: MSC)
A workshop was organised for those Y4 students interested in developing new PAL projects within the
curriculum. Training included a brief interactive presentation on the principles of curriculum
development and an introduction to the project planning and implementation framework which students
subsequently completed with help from MR. Many of the new PAL projects from 2006 onwards have
been initially proposed and planned by students.
New proposals for 2007-8:
 Transfer Student PAL (Organiser: Dr Helen Rodgers)
 Teamwork / interdisciplinary PAL (Organiser: Karen Simpson)
 Y4 Culture and Language PAL (Organiser: MR & Karen Simpson)
 Diabetes (Organiser: Dr Steve Morley)
 Cross-year MBChB Wiki (under discussion)
There are also ongoing discussions among the MTO, Foundation doctors, the Postgraduate Deanery
and Dr Simon Maxwell regarding the development of a near-PAL project involving FY1/2 doctors
leading tutorials for Y5 students on prescribing drugs and fluids.
Evaluation & external review
All PAL projects have included aspects of evaluation, principally paper-based participant
questionnaires and observational feedback from student tutors and / or staff. Generally all participants
(both tutors and tutees) rate PAL very highly. Objective comparison of additional PAL-tutoring on
cannulation vs. normal teaching was explored using the cannulation station in the 2006 Y3 OSCE.
This revealed a very small improvement in exam performance in the PAL-tutored group. Some e-mail
and EEMeC discussion threads have complained about limited places to provide and receive PAL, and
so considerable efforts are underway to provide fair and equitable access.
Aspects of the PAL programme within the Edinburgh MBChB have also been subject to external peer
review, for example:
Ross MT, Cameron HS (2007) AMEE Guide: Peer assisted learning: a planning and implementation
framework. Medical Teacher. Accepted for publication Sept. 2007.
Lynch S, MacSween B, Anderson L, Moyes J, Ross MT (2007) Peer assisted learning (PAL) training
the tutors: a necessary requirement? Presentation at ASME Annual Meeting. Keele.
Ross MT, Pronk S, de Graaf M, Bryden J, Teoh K, Stenfors-Hayes T (2006) How can medical students
learn to teach? Workshop with short presentations at AMEE Annual Conference. Genoa, Italy.
Morton J, Frame F, Anderson L, Moyes J, Ross MT (2006) Development of a peer assisted learning
programme in clinical procedures. Poster presented at AMEE. Genoa, Italy.
Anderson L, Frame F, Morton J, Moyes J, Ross MT (2006) Peer assisted learning in the clinical skills
lab. Poster presented at ASME Annual Scientific Meeting. Aberdeen.
Ross MT, Cumming AD (2005) Peer assisted learning. In: Harden RM, Dent JA, editors. In: A
practical guide for medical teachers, 2nd edition. Edinburgh, UK: Elsevier.
Future developments
 Learning opportunities for teaching others will be fully mapped across the MBChB and details
of this, along with appropriate resources and links, will be added to the ‘Teaching Others’
domain of the EEMeC PPD pages.
 The PAL area of EEMeC will also be developed and linked from within the PPD pages and to
relevant modules of the MBChB (e.g. anatomy and clinical procedures).
 All new PAL proposals will be expected to conform to the PAL precepts (if approved by
Curriculum Executive) and to complete and circulate a PAL planning framework detailed
above for approval prior to implementation.
 Currently efforts are focused on ensuring all Year 4 students have the opportunity to
participate as a PAL tutor on one of the many projects available. It is proposed that a lecture
introducing key concepts about Teaching others and PAL is offered to all Year 4 students
early in 2007-8, and that the available opportunities are outlined, of which students can
initially select one from which they feel they would obtain most benefit.
 In time the goal would be to embed PAL within the formal curriculum, perhaps as an
additional Year 4 Student Selected Component.
Dr Michael Ross
PAL Coordinator
The Medical Teaching Organisation
College of Medicine and Veterinary Medicine
2nd July 2007